Tidewater Doctors LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TIDEWATER DOCTORS LLC

Practice address

2270 Ashley Crossing Dr Ste 155
Charleston, SC 29414-5749

Phone

(843) 990-5866

Fax

(843) 868-8041

NPI assigned

Sep 24, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrea Hurley

Title

Practice Administrator

Phone

(843) 200-7721

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Tidewater Doctors LLC

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1932870318

  O20211109001955

  Same enrollment
• Tidewater Doctors LLC

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1992474654

  O20211109001955

  Same enrollment

Tax ID family

Tidewater Doctors LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Tidewater Doctors LLC

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1932870318
  NPD tax ID
• Tidewater Doctors LLC

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1992474654
  NPD tax ID

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey M Akhtar, DO

  • Internal Medicine Physician
  • Charleston, SC
  • NPI 1053370841
  NPD
• Amelia C Fairfax, MD

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1629147848
  NPD
• Donald P Hurley, D.O.

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1043206410
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1821769290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2834 AQUADUCT ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294147410",
            "telephone_number": "843-200-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2270 ASHLEY CROSSING DR STE 155",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145749",
            "telephone_number": "843-990-5866",
            "fax_number": "843-868-8041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER DOCTORS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-24",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "843-200-7721"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Thrall, PHARM.D.
• Veronica Casim Thrasher, NP
• Thrive Speech Therapy LLC
• Jill Neumann Tibbetts, PA-C
• Annette D Tickle, RN
• Tidewater Doctors LLC
• Tidewater Doctors LLC
• Tidewater Internal Medicine II LLC
• Tidewater Internal Medicine, LLC
• Elizabeth Blair Tiller, CNM

• Internal Medicine Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.